goitre, by causing them to drink from a spring; since it is highly probable that the river-waters of Switzerland contain the deleterious agent, whatever that may be. It is fortunate, however, that, in iodine, we now possess a very powerful counteractor of this mysterious poison.

27. BROUSSAIS AND CLUTTERBUCK IN DANGER.

The fevers which have prevailed during the summer and autumn in London, shewed such a low type, and affected so many different organs, that even the disciples of Dr. Clutterbuck have maintained, under his own presidency, in Bolt-court, that the mucous membrane of the stomach and bowels was much more frequently the primary seat of fever than the brain. This is a melancholy circumstance. No theory of fever is now likely to last more than a few years; for these vile constitutions of the elements around us mock the sublimest genius, and turn all his fine-spun hypotheses into ridicule !

In Paris, dismay prevails among the "gastro-enterite" gentry. M. Honoré has had the courage to proclaim before the Academy of Medicine, that the reigning fevers, as well as other diseases of the French Metropolis, have changed their character; and that, instead of being inflammatory (as they have been for 20 years past) and requiring bleeding and antiphlogistic treatment, they are, on the contrary, exasperated by these means, and require the quinine! In the hospital Necker, as well as in private practice, he has had numerous cases under his care, where, “notwithstanding the symptoms of gastric irritation, they were increased by bleeding and leeching, and cured by bark." The phalanx of Broussais made, of course, a decided stand against this rebellion, and overpowered by numbers the anti-gastric party. But even the disciples of Broussais were forced to acknowledge that quinine did cure periodical fevers-" même de Nature inflammatoire ;" but then they thought it was only when the gastro-enterite had begun to subside! What shifts and subterfuges will the theorists fly to, when facts fail them! The editors of the ARCHIVES wisely remark, that M. Honoré's paper was very useful as a check on the abuse of antiphlogistics in the reigning fevers. "We must not," say they, "confound fever with inflammation, nor conclude that all fevers have local inflammations for their bases." They maintain that there may be inflammations as well as fevers of an asthenic nature, or at least arising from asthenic causes, and consequently not bearing antiphlogistic treatment.

28. INCONtinence of urine.

M. Samuel Lair read lately to the Academy of Medicine a memoir on this subject. He refers most cases of incontinence of urine to a want of equi librium in power between the body of the bladder and its neck—the latter being in an atonic state. The failure of tonics, in these cases, he attributes to their acting equally on all parts of the bladder. He therefore imagined that, if he could stimulate the neck of the bladder and not the body, he might have better success. With this view, he introduced, by means of a catheter, tincture of cantharides so as to touch the urethra in its prostatic part, and also the neck of the bladder. By this process he cured three patients who laboured under incontinence of urine.

29. WOUND OF THE HEART.

At a late sitting of the Royal Academy of Medicine, Paris, M. Ferrus read the particulars of a case of this kind. A lunatic, 34 years of age, pushed into his left side a long but narrow and sharp instrument, and two days afterwards was admitted into the Bicètre Hôpital, the wound being nearly cicatrized, but very painful to the touch. The pulse was small, and intermitting the breathing laborious-and below the wound an undulating sound was heard, like the passage of blood through a varicose aneurism. The patient affirmed that he had not withdrawn the instrument by which he had inflicted the wound. General and local blood-letting was employed; but the breathing became more and more difficult every day, and the patient died on the 20th day from the date of the wound. On dissection, ten or twelve ounces of reddish sanies were found in the cavity of the pericardium, mixed with fibrinous clots. The pericardium itself was inflamed and thickened, and a steel stylet was found implanted in the parietes of the left ventricle of the heart, the point of the instrument having penetrated some lines into the cavity of the right ventricle, after traversing through the left. -Revue Med.

30, SYMPATHETIC EPILEPSY.

Two cases of this kind are reported in the Lancet of November 18, 1826, as occurring in St. Thomas's Hospital. The first was a boy who had been affected with epilepsy three months, having generally three or four fits per diem. These were preceded by an aura epileptica running from the toes of both feet up along the front of the legs and thighs, the abdomen and chest, at the top of which the two auræ met, when the epileptic seizure always took place. The progress of the aura required about a minute and produced a sensation like that arising from the crawling of an insect. Dr. Elliotson directed half a grain of the cuprum ammoniat. thrice a day, and a ligature to be applied tightly round each thigh at the commencement of the fit. The ligatures were not properly managed at first, and the fits continued; but afterwards they were more strictly attended to, and the fits ceased. The boy was discharged, but again received, the fits having returned. The ligatures were now trusted to entirely, and the paroxysms disappeared.

In the second case, the aura epileptica also arose from the feet and ascended to the neck, where the streams united, and then the paroxysm occurred. In this case, the ligatures were tried, but totally failed. It is said, however, that the height to which the streams of aura epileptica mounted, was gradually lessened. When the report closed, the fits were more severe than at first.

The aura epileptica is one of the most puzzling phenomena of this disease. The stream does not seem to run in the course of any particular nerve, artery, or muscle, but travels over, all parts indiscriminately till it reaches the sensorium. The ligature, we apprehend, will never do much for the cure of epilepsy. It is too mechanical a remedy. It is very unlikely that the real source of the irritation is in the place where the aura appears to commence. The plan of stopping it by ligature has long ago

been tried, and failed.

31. FISTULA IN PERINEO CURED BY OPERATION.

Mr. White, of the Westminster Hospital, has lately been successful in a bad case of the kind. The patient had been in two or three hospitals

previously for a fistula in perineo, occasioned originally by a wound in that part. Mr. White introduced a staff as far as the stricture surrounding the opening, and then cut down in a line with the original direction of the urethra, till the whole of the strictured part was laid open. A gum catheter was then introduced into the bladder through the urethra, and left there. This was afterwards changed for a silver catheter, and the wound granulated over the instrument. In about a month the urine ceased to ooze from the wound, and in three weeks more the wound was closed. The strictured parts were found to be in a very indurated state when divided. The operation is not new; but we understand the case was very ably managed by Mr. White.

32. CAUSTIO IN INFLAMMATION OF THE ABSORBENTS.

In a former number we gave a full account of Mr. Higginbottom's experience of the argentum nitratum, as an application in several surgical complaints. We have not the smallest doubt that both the internal and external use of this valuable, medicine will be soon extended. The present communication of Mr. H. respects the application of caustic to inflamed absorbents. Three cases are related, of which we shall briefly notice the particulars.

Case 1. A woman had an ulcer formed, in four or five days, from a furuncular swelling on the forearm, near the wrist, with inflamed and irregular edges, the absorbents leading from the part, up the arm, being also inflamed. The nitrate of silver was applied to the ulcer and surrounding inflammation, as also along the inflamed absorbents. The inflammation was checked in twenty-four hours, and she was soon well. She took some blue pill and salts and senna.

Case 2. A girl, 11 years of age, had a fall on her elbow, 14 days preyiously, which caused a wound, the size of a six-pence, and from neglect, it became inflamed and highly irritable; the absorbents were also inflamed, as indicated by red lines running up to the axilla, where the glands were enlarged and tender. She had shiverings, furred tongue, head-ache, loss of appetite. Mr. H. applied the caustic along the inflamed absorbents, over the tumour in the axilla, and slightly over the wound. Gold-beater's skin was applied over the ulcer, and the other parts were left exposed to the air. No medicine whatever was given. She passed a restless night, but expressed herself relieved next day, the inflammation of the absorbents having much subsided. On the second morning, she made no complaint. The eschar remained adherent on the wound. On the third morning she was quite well.

Case 3. This was one of diffuse phlegmonous inflammation. A young lady presented herself with swelling, hardness, and redness of the skin, seated in the ham, and extending along the back part of the thigh and calf of the leg, which had been increasing for four or five days, without any assignable cause. The patient was feverish the inflammation had a phlegmonous character. The lunar caustic was applied over the whole surface of the inflammation, the part being previously moistened with water. It may be necessary here to observe, that Mr. H. always applies the caustic in the solid form, and finds a slight application sufficient, if it passes over

Mr. Higginbottom. Lond. Med. Journ. No. 3.

every part of the inflamed surface. On the inside of the hands and feet, where the cuticle is thick, a freer application may be made, as vesications do not so readily take place; but even in these parts, Mr. H. has not found it necessary to use it very freely. He always removes any moisture which may be left on the part by means of a little linen or lint. The young lady did not return next day, as she was desired. Three days afterwards, when sent to, she reported herself well. Mr. H. visited her, and found no vestige of inflammation or swelling. A slight vesication had been caused the day after the application of the caustic, and the cuticle was separating. No pain was experienced from the application.

The views of Mr. Higginbottom seem to derive support from the practice of Baron Larrey, as reported in our number for July Last.

33. PUNCTURED WOUND OF THE POSTERIOR TIBIAL ARTERY.

A formidable case of this kind lately occurred at Bartholomew's Hospital. A young man was wounded by a piece of iron in the calf of the leg, succeeded by considerable hæmorrhage. When received into hospital, the limb was much swollen and very tense. It was not suspected by Mr. Lloyd that the artery was wounded, and the usual means of reducing inflammation were employed. Three weeks passed away, without any reduction of the swelling, and Mr Lawrence was induced to think that a large vessel had been wounded, though he did not believe that vessel to be the posterior tibial artery. One part of the swelling softened and was opened, when a quantity of blood and pus issued, apparently from a deep source. The wound was enlarged, and the artery was felt pulsating. Mr. L. proposed amputation as the best remedy, and it was consented to. On examining the leg, a large cyst was found, whence a pound of pus and blood was evacu ated. The posterior tibial artery and vein were discovered to be wounded, and this was the source of the mischief.

This case is fully detailed in No. 169 of the Lancet.

34. EXPERIments on THE BILE.-MR. MAYO.

Our readers will remember the experiments of Mr. Brodie on this subject; by which it appeared that ligature of the ductus communis choledochus of animals completely prevented the formation of chyle from the food swal lowed. Magendie, in his work on physiology, states that he repeated Mr. Brodie's experiments, but with dissimilar results. This led Mr. Mayo, assisted by Mr. Cæsar Hawkins, to go over the same ground with his countryman Mr. Brodie, and his experiments, detailed in the October number of the Medical and Physical Journal, tend to confirm the conclusions to which Mr. Brodie had previously come. It will be unnecessary to do more than glance at these experiments, having already given the substance of Mr. Brodie's paper in our Journal, for June 1823, page 186, et seq. The experiments were performed on cats and dogs, some of which died after the operation, and others were killed; but in none of them did the least trace of chyle appear in the intestine or lacteals. Mr. Mayo thinks that Magendie may possibly have been led into error by mistaking the empty mesenteric arteries for lacteals containing chyle.

35. VICARIOUS MENSTRUATION."

Much and unnecessary scepticism obtains, especially among the less experienced part of the profession, respecting vicarious discharges. Many will not believe in the existence of phenomena which they cannot account for—though, heaven knows, there are very few phenomena, whether of health or disease, which are capable of satisfactory explanation. The case which Dr. Barnes has related in our esteemed contemporary of the North, will doubtless be looked upon as rather fanciful, by those who do not know the multitudinous forms which hysteria and suppressed menstruation occasionally assume in females of delicate organization and susceptible nerve. We have seen many cases much more puzzling than the one related by Dr. Barnes, and some of these we have put upon record. A vicarious discharge of blood from the lungs is no uncommon occurrence, under the circumstances in question, and discharges from other organs and parts, (in impeded menstruation,) of such strange and unnatural qualities sometimes take place, as would not be credited by those who were not eye-witnesses of them. We shall now briefly state the case of Dr. Barnes' patient, which is rather prolix in the original.

Case. The patient is now 30. In youth, she was subject to catarrhal complaints, and occasionally to aphonia. At 14, she menstruated, but the returns were not regular, varying from three to six weeks, and the periods painful. At the age of 19, (1815) she had an attack of hæmoptysis, attended with unfavourable symptoms, as short cough, quick pulse, &c. These gave way to bleeding, blistering, digitalis, &c. Then came on symptoms of hepatitis, for which she was bled, blistered, and mercurialized. After this she remained in a bad state of health for two years, having pain in the region of the liver, dyspnoea, palpitation, indigestion, thirst, &c. The menses, in the course of this (the hepatic) complaint, entirely stopped. 1816, aged 21. She was again attacked with hæmorrhage from the lungs, which lasted three days. In eight months, another hæmorrhage took place, and the seizures of hæmoptysis after this came on gradually but progressively, at shorter and shorter intervals. Between 1817 and 1820, the intervals varied from six to ten weeks, and she had always the premonitory sensations of tightness across the chest, with sense of weight in the region of the heart, pain in the left hypochondrium, and difficulty of breathing, without cough. These premonitory sensations led to blood-letting, as preventive of the hæmorrhage; but no relief ever took place till the hæmoptysis occurred, excepting the sense of suffocation was removed by the venesection. Larger quantities of blood from the arm were then tried, as prophylactics, but in vain.

In 1820, soon after a pulmonic hæmorrhage, she was seized with a violent pain in the right side of the head, which forced her to spring from her bed. A discharge of clear water took place from the right ear, and this discharge is said to have returned every eight or twelve hours, for ten days. It was calculated that a teacupful was discharged at each of these times. When Dr. B. first saw her, in June 1820, the lady was much emaciated, pallid, and feeble, with pulse at 100-bowels open. We cannot follow Dr. B. in his minute details of the attacks of otorrhoea serosa, and the remedies that were tried for it. But we cannot help remarking on the somewhat confused statements which Dr. B. has made. Thus, at page 274, we are informed,

Case of vicarious Menstruation, with singular Discharge from the Ear, with Remarks. By Thomas Barnes, M. D. &c. &c. Ed. Journ. Med.. Science, No. 4.